Endometrial Ablation vs Hormonal Coil

Endometrial ablation is a procedure that treats the womb lining to reduce menstrual bleeding. A hormonal coil is a small device placed inside the uterus that releases a progestogen over time. Both may reduce heavy periods, but they are different commitments: ablation is a procedure intended to change the lining, while the coil is reversible and also acts as contraception.

Endometrial ablation treats the womb lining, while a hormonal coil releases medicine locally and can also provide contraception.

Endometrial ablation reduces the womb lining, while a hormonal coil releases medicine locally and can also provide contraception.

Ablation may be discussed when heavy menstrual bleeding is the main problem, medicines have not helped enough, and pregnancy is not wanted in the future. It is not suitable when pregnancy is possible or when the uterine cavity has a problem that needs another treatment. The clinician may investigate the cause of bleeding first, because ablation treats the lining rather than every source of pelvic symptoms.

A hormonal coil may suit someone who wants reliable contraception alongside help with heavy periods, or who prefers a reversible option before considering a procedure. It can be useful when avoiding surgery matters, although irregular bleeding or spotting may occur while the body adjusts. A clinician checks the uterus and reviews infection risk, pregnancy possibility and previous pelvic problems before insertion.

After ablation, cramping, discharge and temporary bleeding can occur, and some people may need further assessment if bleeding returns or persists. A hormonal coil can cause cramping during insertion, spotting and changes in bleeding pattern; it can also move or come out and requires clinical review if pain or unusual bleeding develops. Neither option should be used during a possible pregnancy. Seek urgent care for severe pain, fainting, fever or very heavy bleeding.

Neither option is automatically right when bleeding is caused by a large fibroid, a uterine abnormality, a medication effect, or a condition needing tissue assessment. Medicines, treatment directed at a fibroid, diagnostic sampling or another operation may be considered. The plan should also account for anaemia symptoms, pain between periods, bleeding after sex and whether future pregnancy remains a possibility.

The recommendation is based on the cause and pattern of bleeding, uterine size and shape, contraception needs, pregnancy plans, medical history and your tolerance for insertion or a procedure. Ask what improvement is realistic, what follow-up is needed, and what happens if bleeding continues. Further reading is available for [Endometrial Ablation](/treatments/gynaecological-surgery/endometrial-ablation/) and [Hormonal Coil](/treatments/contraception-and-family-planning/hormonal-coil/).